Loading...
PL-14-2704 Miami Shores Village Buildin g p De artment c °'4 �� 10050 N.E.2nd Avenue, Miami Shores,Florida 3313E Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 . ,, BUILDING Master Permit No. /<., � PERMIT APPLICATION Sub Permit NoR_ N-270 ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION Ej EXTENSION [:]RENEWAL LUMBING ❑ MECHANICAL ❑PUBLICWORKS ❑ CHANGE OF CANCELLATION 0 SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County Miami Dade Zip: �� 3 6 Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: ����OWNER: Name(Fee Simple Titleholder): ko� � t �(`�� Phone#: 294 30 Z3 JI Address: 50 ,PJ £ . 9 I T7}' City: K Ar.; Shore t State: P C_ zip:3313 8 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: Address: r City: State: ® Zip: 3�17-7 Qualifier Name: M1j fV 0k1l-' PAIAPC /l� �� Phone#: State Certification or Registration#: 331 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration F-1New ❑ Repair/Replace F-1Demolition dd Description of Work: MW L., �_ Specify color of color thru tile: Submittal Fee$ Permit Fee$ 215. CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ evised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU R.NOTICE.OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. in the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTCTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 2q'<A day of 7,N00e 20 by day of t� It 20 by who is Personally known to f"(��� PbW fkcj — e�Xo is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: k-1 Sign: VaJA. .lJ Print: Tlyacrlpv) Print: 05RaC T— h Seal: C.PARRISH Seal: MY COMMISSION#EE1533% C.PARRISH EXPIRES:DEC 14,2015 ,�►�" Bonded tlRoughlst Site hismnce = n MY COMMISSION#EE153394 * ************** * ************** **� W*Vi4**nded through lot State Insurance APPROVED BY `i.•//'7 Bo Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 -41940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 PAMPIN JIMENEZ, MANUEL 5STAR PLUMBING SERVICES CORP 11710 SW 180 ST MIAMI FL 33177 Congratulations! With this license you become one of the nearly — - - - one milllan Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range ,a STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND and they keep Florida's economy strong. PROFESSIONAL REGULATION Every day we work to improve the way we do business in order to CFC1428573 ISSUED: 05/14/2014 serve you better. For information about our services,please log onto www.myfloridaticense.com. There you can find more information CERTIFIED PLUMBING CONTRACTOR about our divisions and the regulations that impact you,subscribe PAMPIN JIMENEZ,MANUEL to department newsletters and learn more about the Department's initiatives. 5STAR PLUMBING SERVICES CORP Our mission at the Department is:License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expiration data:AUG 31,2016 L140514000MG DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD = o� CFC1428573 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 PAMPIN JIMENEZ, MANUEL •® 5STAR PLUMBING SERVICES CORP 11710 SW 180 ST 6,' MIAMI FL 33177 ISSUED: 05/14/2014 DISPLAY AS REQUIRED BY LAW SEQ# L1405140000920 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 11/19/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NANTFFT GRETELL GONZALEZ PHOUSA General Insurance Corp(USA Insu M&mFjdl: (305)386-3305 FAx No): (888)330-1123 5841 S.W.137th Ave. AE-IMILDDRESS. GRETELL@USAGENERAUNSURANCE.COM Miami,FL 33183 INSURER(S)AFFORDING COVERAGE NAIC# Phone (305)386-3305 Fax (888)330-1123 INSURERA: WESTERN WORLD CO INSURED INSURER B: 5 STAR PLUBLING SERVICES CORP INSURERC: 11710 SW 180TH STREET INSURER D: MIAMI,FL 33177 (305)796-3607 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRTypE OF INSURANCE AD UB POLICY EFF POLICY ECP LIMITS INR D POLICY NUMBER MMID MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000.00 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000.00 F-] F-] CLAIMS-MADE0 OCCUR JHZGY-B MED EXP(Any one person $ 5,000.00 A N N 02/90/2014 02/10/2015 PERSONAL BADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 1,000,000.00 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 POLICY 1:1 PECTRO ❑ LOC $ ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY a aca ant ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ALOWNED ❑ SSCC�HE ULED BODILY INJURY(Per accident) $ F] HIRED AUTOS ❑ AUTOS D Perr Paccid YntDAMAGE $ ❑ ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑TWOC STATU- ❑OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more apace Is required) STATE CERTIFIED PLUMBING CONTRACTOR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVE AUTHORIZED REPRESENTATIVE MIAMI SHORES FL 33138 GZ-11�� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD 010267 Az - Business Tax Recei{1t MraMi•-pada COUT"' SWte of Fion a -TINS is NOTA IKL -DO NOTPAY 6936 tot "NOS"NAa,,a/LOCATm racmi-T no. EXPIRES 5 STAR PU MINNG SERVICES CORP IN NINIAL SEPTEMBER 30,2015 11710 SW 180 ST 7238391 Must be displayed at place of business MIAMI€L 33177 Pursuant to County code Chapter BA-Art.9&10 OM/IVBR SEC.TVM OF 61t8MESS p4►YaaFNT p;FG3tVBD 5 STAR PLUMBING SERVICES CORP 196 PLUMBING CONTRACTOR sv rr►x coI Lgeron 1ArarlcaT(s) 1 CFC1428673 $75.00 47/17/2014 CHEC6=14-023722 Two Lacs)BiffiIAeu lax Racalpa osl� mal tae Laeal B®Ia�aTa:T!s MR gang p, a�tloaoft6stoaWa to do laslassa.dwb im eowlN ea npslatawIrm T'r raYcMgphaatir6aaisaaa The RECEIPTN0.abwvwMIwdkFh WaaMoaw�aaCW `�aFOHaCedaSeeBrZ18 Ferasss ao Im JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF!WORKERS'COMPENSATION "CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 2/26/2014 EXPIRATION DATE: 2/26/2016 PERSON: PAMPIN-JIMENEZ MANUEL FEIN. 454102224 BUSINESS NAME AND ADDRESS: 5STAR PLUMBING SERVICES 5 STAR LEAK DETECTION 11710 SW 180 STREET MIAMI FL 33177 SCOPES OF BUSINESS OR TRADE: LICENSED PLUMBING CONTRACTOR Pursuant to Chapter 440.05(14),F.S.,an officer of a corpm don who elects exemption from this chapter by f ing a certiflca to of election under this section may not recover barnefits or cornpaiumbn under this chapter.Pursuant to Chapter 440.05(12),F.S.,Cerdcates of election to be exempL.apply only within the scope of the business or trade Usted on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of at If to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the cartficate,the parson named on the notice or conflate no longer meets the requirements or this sermon for issuance of a eertifccate.The department shall revoke a cert)6rate at any time for failurs of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE E)MMPT REVISED 07-12 QUESTIONS?(1350)413-1609 . 1 Miami Shores Village Building Department LpR�pA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner— Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: I. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company. Therefore,you maybe Personally liable for the worker compensation injuries of any person allowed to work under this permit. Please check with your I insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Owner Contrctor ' Print Name � � I �`"� Print Name: C Signature: Signature: State of Florida) State of Florida} County of Miami-Dade) County of Miami-Dade) Sworn to and subscribed before me t s�� Sworn to and subscribed before me this Cl day of DeC� �jP�'20 day of DeceMbes _,20 l ` ' j, YYII pin�f & YY11 11 By Q By P Tmgtma 11e _�► __ f 133745 r 0115: , 110 8. 2018 (SEAL) (SEAL) W(11 2 �° WWW.MRON MT.CQY T entifrcation produced L,• T of Identification producedon411 nOv M Miami Shores Village " uilding Department 1 N.E.2nd Avenue,Miami Shores, Florida 33138 rt. Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 rDING Master Permit No. Kc- PERMIT APPLICATION Sub Permit No.,?,—'" 114 _ 2_3 0�[ ❑BUILDING ❑ ELECTRIC ❑ ROOFING REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: �. C) qm4k City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFrE:: FFE: 1� OWNER: Name(Fee Simple Titleholder): o(jE-mo Upz, � Phone#: 3- A� ,3F7 Address:S� Ne. 9 1 1 City: k IC,"N I 1 S�.yrf J State: L zip: '33 ( 18 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: 5 -S 1l ` ,' Phone#: ��� �� "` L o4- Address: LO. I ° 0 City: State: L Zip:_33 ( 4� 22 Qualifier Name: 261 %M O"r1 Phone#: 3 J 49 State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Scno Y9 Square/Linear Footage of Work: Type of Work: ❑ Addition V❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: I{ Specify color of color thru tile: Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ CU' (Revised02/24/2014) h Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS,HEATERS,TANKS,AIR CONDITIONERS,ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature Si g OWNER or AGENT CO OR The foregoing instruri e1pt was acknowledged before me this The foregoing instrument was acknowledged before me this 17,6 day of v OLVA I�LC�f-� 20 `� , by day of G A u_ ,20 1`J , by 01564TO �'��® ,who is personally known to ,who is personally known to me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: L) Y)", ki Sign: Sign: Print: ��i�1� � Print: ia(-C\4) Seal: C.PAWM Seal: C.PARRISH �o MY COMM I#EE1WW to MY COMMISSION#EE151 EXPIRES:DEC 14,2M5 FXPIRES:DEC 14,2015 Bonded On*181 Slate Intiume WOO mrough 1 et Slate InSURM **w*** **** **********x* ** ***** *rix* APPROVED BY Z��ysJ Plans Examiner Zoning Structural Review Clerk (RevisedO2/24/2014) A,6R1 DATE @WOD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 02/18/15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: O the holder is an ADDITIONAL INSURED,the pollcy0es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to tate certificate holder in Hsu of such endorsemenl[s4 PRODUCER W. GRETELL GONZAL.EZ USA General Insurance CoIpIIJSA IrrsuPHONE o (305)386 3305 � , (305)388.8778 5S.W.137th Ave. DD'a 841 GRETELL@USAGENERALINSURANCE.COM Miami,FL 33183 AFFORDING COVERAGE NAIC rt Phone 05)386-3305 Fax (888)330-1123 INSURER A: CAPACITY INSURANCE COMPANY INSURED INSURERS: 5 STAR PLUMBING SERVICES CORP INSURER C: 11710 SW 180TH STREET INSURERD: MIAMI,FL 33177 (305)736-3607 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY INR TYPE OF INSURANCE AED POLICY NUMBER MIDI EFF POLICY DIP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © NTED COMMERCIAL GENERAL LIABILITY PD EM SES ETO a occurrence $ 100+000•00 r] ❑ CLAIMS-MADE Q OCCUR CLM01009856A MED EXP(Any one person $ 5,000.00 A 11N N 02/10/2015 02/10/2016 PERSONAL&ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,0DO.000.00 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 1,000,000.00 ❑POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ❑ ANY AUTO BODILY INJURY(Per person) $ ❑ ��OWNED ❑ SCHEDULED BODILY IN.IURY(Per accident) $ F1HIREDAUTOS E] TNAU�t�DPR P� $ ❑ ❑ $ ❑ UMBRELLA A LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ❑WC STATMU ❑A"AND EMPLOYERS'LUUMSrY Y/N ANY PROPRIETOMPARTNEWDIECUnVE EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A n (Mandatory In NH) a E.L.DISEASE-FA EMPLOYE $ If yyeess dascribe under DES JPTION OF OPERATIONS below E.L DISEASE-POUCY LIMIT $ DESCRFP71ON OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,AddMand Rerrerka Schedule,Ir more space Is required) State Licensed PlUmbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL ED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL.BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITIi THE POLICY PROVISION. 10050 NE 2ND AVE AUTHOR®REPRESENTATIVE MIAMI SHORES FL 33138 _ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25120101061 OF The ACORD name and logo are realstered marks of ACORD